Organization
FAIRVIEW PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY BRUCE MOT, OTR/L (OCCUPATIONAL THERAPIST/CO-OWNER)
(615) 582-2942
Entity
Organization
Contact information
Practice address
2092 FAIRVIEW BLVD STE 103, FAIRVIEW, TN 37062-6012
(629) 250-9317
Mailing address
7716 HUDLOW CT, FAIRVIEW, TN 37062-7331
(615) 582-2942
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q004435
—
TN
05
—
Q031734
—
TN
Enumeration date
08/04/2022
Last updated
08/25/2022
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